Healthcare Provider Details

I. General information

NPI: 1649272337
Provider Name (Legal Business Name): DOUGLAS JAY ROGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE W-201
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

PO BOX 960
PALM SPRINGS CA
92263-0960
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4511
  • Fax: 760-416-4512
Mailing address:
  • Phone: 760-416-4511
  • Fax: 760-416-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG77670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: